Dr. Matthew Freiberg is a clinical instructor in the General Internal Medicine Section at the Boston University School of Medicine and research collaborator at the Framingham Heart Study who seeks a Mentored Patient-Oriented Research Career Development Award (K23) in order to transition to an independent clinician investigator. This proposal focuses on the association of alcohol to coronary heart disease (CHD) in adults with HIV. In adults without HIV, the association between alcohol and CHD is "J" shaped, with heavy drinkers at the highest risk, abstainers at intermediate risk, and moderate drinkers at the lowest risk. With improved survival of adults with HIV, CHD is now prevalent in this population, however, the risk of CHD associated with alcohol in adults with HIV is not known. As alcohol use is common in adults with HIV, Dr. Freiberg will test the following hypothesis by pursing three specific aims: In adults with HIV the association between alcohol and CHD risk is "J" shaped. Aim #1 will evaluate the cross-sectional association between alcohol and CHD risk using the Framingham Risk Score, a validated composite measure of CHD risk. Aim #2 will evaluate the cross-sectional association between alcohol and prevalent CHD using multivariable logistic regression. Aim#3 will prospectively evaluate the association between alcohol and CHD mortality using proportional hazards models. Aims #1 &2 will be addressed by studying the HIV LIVE (Longitudinal Interrelationships of Viruses and Ethanol Study) and Veterans Aging Cohort Study (VACS) cohorts. Aim #3 will be addressed using the Virtual VACS with the 1999 Large Health Survey of Veteran Enrollees. Together, these cohorts provide detailed data on alcohol use, CHD risk factors, CHD, and mortality. Experts in the fields of moderate and heavy alcohol consumption, HIV and HIV-related co-morbidities, alcohol problems in HIV, and CHD epidemiology will supervise Dr. Freiberg's career development. He will receive (1) specific training in advanced epidemiologic and statistical techniques at the Boston University School of Public Health and the Framingham Heart Study and (2) the skills necessary to initiate and maintain an active cohort of alcohol affected study participants. As alcohol consumption and CHD are two important health issues facing adults with HIV, understanding the risks of CHD associated with alcohol will be important to expert panels creating consumption guidelines and health professionals who advise patients with HIV.